Reflux surgery no guard against throat cancer

NEW YORK (Reuters Health) - Patients who have surgery to treat severe heartburn -- also known as gastroesophageal reflux disease or GERD -- continue to have a very high risk of developing cancer of the esophagus even after 15 years or more, a new study has found.

GERD is a known risk factor for esophageal cancer. "This study should put to rest the notion that antireflux surgery prevents esophageal cancer. It was always a viewpoint based more on hope than data but, now that the data are in, the conclusions should be accepted," said Dr. Peter J. Kahrilas, professor of medicine at Northwestern University's Feinberg School of Medicine in Chicago, who was not involved in the study.

"This population-based data set spanned 40 years and encompassed essentially the entire Swedish population. There was not even a trend toward cancer prevention, even decades after the surgery," Kahrilas added in an email to Reuters Health.

The researcher who headed the study, Dr. Jesper Lagergren, professor of surgery at the Karolinska Institute in Stockholm, told Reuters Health, "We expected a decreased risk of cancer with increased time after surgery, but we didn't find it. There is no evidence to support the idea that antireflux surgery prevents cancer development of the esophagus."

GERD is a common disease in which fluid from the stomach backs up into the esophagus, typically causing heartburn and other symptoms. Although GERD can be controlled through lifestyle changes and medication, some patients require surgery to reinforce the valve between the esophagus and stomach. Antireflux surgery has been shown to provide long-term improvement and resolution of GERD symptoms.

To gauge the effect of antireflux surgery on the risk of throat cancer, Lagergren and colleagues analyzed the medical records of Swedish citizens from 1965-2006.

Among 14,102 patients who had antireflux surgery, the overall risk of esophageal cancer was 12 times that in the general Swedish population. The risk did not decrease with time after surgery, they report in the journal Gastroenterology.

According to Kahrilas, "I think that this is now the definitive study assessing whether or not there is a protective benefit of antireflux surgery with respect to preventing esophageal adenocarcinoma, and the answer is a resounding no!"

Why doesn't antireflux surgery protect against cancer? Possible reasons include the continuation of reflux after surgery, the length of time patients had reflux prior to surgery, and its severity, Lagergren said.

To investigate the causes, he and his colleagues are delving deeper into the data. "We are evaluating the surgery itself as well as other risk factors, for example obesity, surgeon experience, and the recurrence of reflux," he said.